How to sit with OCD anxiety

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A key element of Exposure and Response Prevention (ERP/ExRP) therapy is conducting exposure practice, while learning to sit with the discomfort that the exposure prompts.

But what exactly does it mean to "sit with the discomfort?"

In short, "sitting with the anxiety" means accepting the uncomfortable feelings WITHOUT trying to push them away or escape from them through compulsions like reassurance seeking, checking, or ritualizing. But guess what? As therapists, we also have to specifically give them skills to stop checking, to stop ritualizing, to practice acceptance and to refrain from reassurance seeking. Just because we say they should or shouldn't do something, doesn't mean they have the "know-how" to follow through on our recommendations.

Exposure activities help our clients increase their tolerance of uncertainty related to their OCD themes.

As therapists, our role is to show them how to engage in exposure practices and cut out the compulsions in the most effective way.

Sitting with the discomfort of uncertainty can feel life threatening to our clients with OCD. So they need a lot of support and guidance when first beginning exposure practice, and even instruction on how to do so compassionately.

Our instruction empowers our clients to sit with the anxiety and they come to realize that they CAN in fact handle hard things, no matter how intense the fear feels. It means teaching them how to let the feelings wash over them, so they can realize they're not going to drown if they don't ritualize.